JMIR Diabetes最新文献

Background: Insulin therapy is crucial for type 2 diabetes mellitus management, with increasing usage in Indonesia, and its effectiveness is well-established. However, prescribing insulin poses various challenges that can impact the effectiveness of insulin. Patient education is crucial for the successful implementation of insulin therapy. Proper insulin use remains insufficient in Indonesia.

Objective: This study seeks to investigate physicians' knowledge and practice in providing education on insulin use to type 2 diabetes mellitus patients in Indonesia.

Methods: This study recruited potential participants (all physicians in Indonesia) through the Internet using a convenience sampling method. The participants were asked to fill out a questionnaire. The questionnaire had 32 questions divided into 4 sections, comprising demographics and clinical practice, practice of insulin education, Indonesian insulin injection technique guideline, and knowledge of insulin injection technique. The instrument used in this study was developed based on the Pedoman Teknik Menyuntik Insulin Indonesia (PTMII), which was adapted from the international consensus by the Forum for Injection Technique and Therapy Expert Recommendations (FITTER). The survey lasted from February to March 2021. Data was analysed using Kruskal-Wallis tests.

Results: A total of 823 participants were included in the analysis. A total of 680 out of 823 participants (82.6%) had given insulin education to patients at least once during the last 30 days. However, only 479 out of 823 participants (58.2%) used specific guidelines in their practice, with only 280 out of 823 participants (34.0%) aware of the Indonesian guidelines. Eight hundred and fifteen out of 823 participants (99.0%) agreed that insulin injection techniques would affect clinical results. The median score of knowledge about insulin injection techniques was 7 (interquartile range 2) among the study participants, indicating good knowledge. The profession was the only statistically significant variable associated with knowledge scores, with the highest median score held by consultants in endocrinology, metabolism & diabetes, and the lowest by other doctors (P <.001).

Conclusions: Most physicians in this study had given education to their patients. However, there was still a gap between the guidelines and the practice of insulin education, as shown by the lack of awareness and a fair level of knowledge about the Indonesian guidelines.

Clinicaltrial:

Background: Diabetes mellitus (DM) is a chronic condition requiring effective self-management to maintain glycemic control and prevent complications. Mobile health (mHealth) apps offer potential solutions by providing real-time monitoring, personalized feedback, and educational resources. However, their long-term adoption is hindered by a lack of user involvement in the development process and insufficient cultural adaptation. This study aims to explore the perspectives of patients with DM in Hong Kong on the functionalities and features of mHealth apps, highlighting the importance of tailoring these apps to meet local cultural needs.

Objective: The objective of this study is to understand the views of patients with DM on the development of mHealth apps and the demand for app functions in order to provide a basis for the development of DM prevention apps.

Methods: This descriptive qualitative study conducted semi-structured interviews with 10 patients with DM attending a District Health Centre in Hong Kong in May 2024, using a purposive sampling strategy. The transcribed data were analyzed by the inductive content analytical method, and themes were extracted with the aid of NVivo (version 15.0; QSR International) software.

Results: In total, 7 key themes were identified: accurate information resources, automatic tracking and monitoring of health metrics, reminders, personalized customization options, intuitive usability, efficient data-sharing capabilities, and interactive design. Additionally, the study emphasizes the importance of cultural adaptation and the potential of artificial intelligence-enabled mHealth apps to enhance personalized information delivery. Ensuring the credibility and professionalism of information sources is also essential.

Conclusions: The results provide valuable insights for enhancing the self-management capabilities of patients with DM and inform the future development of mHealth apps focused on DM prevention.

Background: Gestational diabetes mellitus (GDM), a type of blood glucose intolerance or hyperglycemia that occurs during pregnancy, is a common condition increasing in prevalence both globally and in Australia. Mobile health apps have been shown to be a useful resource for women with type 1 diabetes and could successfully contribute to GDM management by facilitating healthy behaviors.

Objective: This study aimed to seek the perspectives of health care consumers (HCCs) and health professionals (HPs) regarding the development of a smartphone app for women living with GDM.

Methods: A co-design process with 4 distinct phases underpinned the development of SugarMumma. Phase 1 involved a nonsystematic literature search followed by the creation of an app functions wish list. In phase 2, semistructured interviews with HCCs and HPs were undertaken and then thematically analyzed. In phase 3, a prototype was designed based on social cognitive theory and stakeholder recommendations. Agile project management methodology was used, followed by "user acceptance testing." During phase 4, a second round of individual interviews was undertaken with HCCs and HPs. The same qualitative methods outlined in phase 2 were used.

Results: In phase 2, individual and didactic interviews were undertaken with HCCs (n=2) and HPs (n=6). Two overarching themes encompassing recommendations for app development emerged: (1) functionality and (2) individualized care. SugarMumma was created in phase 3. Phase 4 involved a second round of individual interviews with HCCs (n=1) and HPs (n=5), resulting in the final theme (3) future directions.

Conclusions: With increasing numbers of people using smartphones, mobile health apps can help manage chronic conditions such as GDM. SugarMumma was designed following extensive stakeholder input. Good functionality, regular notifications, appealing visual aids, positive feedback, relevant dietary advice, and exporting information to HPs are important features to include.

Background: The utility of a nurse-led telemonitoring approach (NLTA) is yet to be firmly established in diabetes management.

Objective: This study aims to examine the effect of a 12-month proactive NLTA on metabolic and psychological health indices in individuals with diabetes during the COVID-19 pandemic, and to evaluate it as a new diabetes model of care.

Methods: The telemonitoring study group (TSG; n=91) comprised adults who had attended an Australian tertiary hospital diabetes center between January 2019 and March 2020. Telehealth surveillance contact with a diabetes nurse educator was subsequently maintained at approximately 3-month intervals over 12 months. Prospective surveillance measures included glycated hemoglobin A1c (HbA1c%), weight, adherence to healthy behaviors, and patient-reported outcomes of diabetes distress, anxiety, and depression using validated instruments. Metabolic changes were compared retrospectively with a comparison group who had not received telemonitoring contact during the study period (non-TSG; n=115).

Results: The average participant age was 57.2 (SD 15) years; 63% (129/206) were male, 48% (99/206) had type 1 diabetes, 50% (104/206) had type 2 diabetes, and the mean HbA1c% was 8.1% (SD 1.4%). At the end of the 12-month study, the relative percentage reduction in unadjusted HbA1c% for the TSG cohort was significantly greater than that observed in the non-TSG cohort (4% vs 1%; P=.04). Following adjustment for baseline HbA1c%, a significant improvement in HbA1c% was observed in the TSG (P=.048) but not in the non-TSG (P=.61). TSG participants were 40% less likely (odds ratio 0.6, 95% CI 0.5-0.7) to experience an unfavorable rise in HbA1c% compared to non-TSG participants, after adjusting for sex, age, prepandemic HbA1c%, ethnicity, diabetes type, and diabetes duration. The NLTA facilitated assessments of psychological risk, with elevated depression, anxiety and diabetes distress scores significantly increased in women and youth <30 years of age (P<.001). Increasing anxiety measures were observed in those with high baseline anxiety scores (P<.001).

Conclusions: A proactive diabetes NLTA is feasible with positive effects on glycemia and the potential to identify those at psychological risk for targeted intervention. In the context of increasing demand for diabetes-related resources, further study of an NLTA model of care is warranted.

Background: Pneumonia is the most common respiratory tract infection among patients with diabetes, affecting individuals across all age groups and sexes.

Objective: This study aims to examine demographic trends in mortality among patients diagnosed with both diabetes mellitus (DM) and pneumonia.

Methods: Deidentified death certificate data for DM- and pneumonia-related deaths in adults aged 25 years and older from 1999 to 2022 were obtained from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) database. Age-adjusted mortality rates (AAMRs) per 1,000,000 population were calculated. The Joinpoint Regression Program was used to evaluate annual percentage changes (APCs) in mortality trends, with statistical significance set at P<.05. This study adhered to the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines for reporting.

Results: Between 1999 and 2022, a total of 425,777 deaths were recorded from DM and pneumonia. The overall AAMR declined significantly (P=.001) from 98.73 in 1999 to 49.17 in 2016 (APC -4.68), and then surged to 97.66 by 2022 (APC 23.55). Men consistently experienced higher mortality than women throughout the study period. Male AAMR rose from 62.61 in 2016 to 127.05 in 2022 (APC 24.88), while female AAMR increased from 41.05 in 2017 to 75.25 in 2022 (APC 27.60). Race-based analysis demonstrated that American Indian or Alaska Native populations had the highest mortality rates among racial groups. Non-Hispanic White individuals exhibited a significant decline in AAMR (P=.002) from 89.76 in 1999 to 44.19 in 2017 (APC -4.58), followed by an increase to 83.11 by 2022 (APC 25.25). Adults aged 65 years or older bore the highest mortality burden, with rates declining steadily to 206.9 in 2017 (APC -5.15) before rising sharply to 371.3 in 2022 (APC 20.01). Nonmetropolitan areas consistently exhibited higher mortality than metropolitan areas, with particularly steep increases after 2018 (APC 64.42). Type-specific mortality revealed that type 1 DM AAMRs declined from 9.2 in 1999 to 1.4 in 2015 (APC -11.94) before rising again. By contrast, type 2 DM AAMRs surged drastically after 2017, peaking at 62.2 in 2020 (APC 58.74) before partially declining to 41.6 by 2022.

Conclusions: DM is associated with an increased risk of mortality following pneumonia, particularly among men, older adults, and American Indian populations. Strengthening health care interventions and policies is essential to curb the rising mortality trend in these at-risk groups.

Background: Artificial intelligence (AI) chatbots have shown competency in a range of areas, including clinical note taking, diagnosis, research, and emotional support. An obesity epidemic, alongside a growth in novel injectable pharmacological solutions, has put a strain on limited resources.

Objective: This study aimed to investigate the use of a chatbot integrated with a digital avatar to create a "digital clinician." This was used to provide mandatory patient education for those beginning semaglutide once-weekly self-administered injections for the treatment of overweight and obesity at a national center.

Methods: A "digital clinician" with facial and vocal recognition technology was generated with a bespoke 10- to 15-minute clinician-validated tutorial. A feasibility randomized controlled noninferiority trial compared knowledge test scores, self-efficacy, consultation satisfaction, and trust levels between those using the AI-powered clinician avatar onsite and those receiving conventional semaglutide education from nursing staff. Attitudes were recorded immediately after the intervention and again at 2 weeks after the education session.

Results: A total of 43 participants were recruited, 27 to the intervention group and 16 to the control group. Patients in the "digital clinician" group were significantly more knowledgeable postconsultation (median 10, IQR 10-11 vs median 8, IQR 7-9.3; P<.001). Patients in the control group were more satisfied with their consultation (median 7, IQR 6-7 vs median 7, IQR 7-7; P<.001) and had more trust in their education provider (median 7, IQR 4.8-7 vs median 7, IQR 7-7; P<.001). There was no significant difference in reported levels of self-efficacy (P=.57). 81% (22/27) participants in the intervention group said they would use the resource in their own time.

Conclusions: Bespoke AI chatbots integrated with digital avatars to create a "digital clinician" may perform health care education in a clinical environment. They can ensure higher levels of knowledge transfer yet are not as trusted as their human counterparts. "Digital clinicians" may have the potential to aid the redistribution of resources, alleviating pressure on bariatric services and health care systems, the extent to which remains to be determined in future studies.

Background: Young adults with type 1 diabetes (T1D) often struggle with self-management and achieving target glycemic control, and thus, may benefit from additional support during this challenging developmental life stage. They are also some of the highest users of social media (SM), which may have some benefits to young people with T1D.

Objective: Given the potential of SM support for people with diabetes, we sought to use qualitative methods to explore the perceptions of diabetes SM posts to influence self-care and emotional state of young adults with T1D.

Methods: A series of Instagram (Meta) posts were selected by a multidisciplinary team of T1D experts. Young adults aged 18-25 years with T1D duration of 1 year or more were recruited from the clinic to participate in a 60-minute semistructured videoconferencing interview. First, they were queried about their SM use in general and specific to diabetes. Next, they reviewed 10 posts with the interviewer. For each post, perceptions and reactions were queried. Participants were asked about each post's impact on their emotional state and potential influence on diabetes self-care. Finally, they were asked to comment on what the posts emphasized and how they felt after viewing the posts. Interviews were transcribed and coded using thematic analysis. The participants' diabetes management information was extracted from the electronic health record.

Results: There were 26 young adults who completed the study. Their mean (SD) age was 22.6 (SD 2.0) years, T1D duration 12.6 (SD 5.9) years, and glycated hemoglobin (HbA1c) 7.6 (SD 1.2%). In this sample, 65.3 were female and 84.6% White. All were using continuous glucose monitors (CGMs) and 80.7% used insulin pumps, 71.4% of which were hybrid closed loop. All participants used SM at least once daily, but most only sometimes or rarely used SM to access diabetes content and rarely or never posted diabetes content themselves. Major themes arising from the interviews centered on the potential for the young adult to connect emotionally through SM, which could be either positive or negative. Overall, for young adults with T1D, SM served to (1) highlight the existence of a community of people with T1D, (2) be a source of new diabetes information, (3) potentially influence diabetes self-management, (4) potentially influence emotional state, and (5) be appealing to the T1D community when the posts possessed certain characteristics (eg, medical accuracy, aesthetically appealing presentation of content).

Conclusions: SM has the potential to help young adults with T1D feel a sense of community, seek and share objective and subjective thoughts and feelings about diabetes, motivate diabetes self-care, and positively affect emotional state. However, it may also have the potential to demotivate self-care and exacerbate negative emotional state with regards to diabe

Background: Continuous glucose monitoring (CGM) is used to assess glycemic trends and guide therapeutic changes for people with diabetes. We aimed to increase patient access to this tool by equipping primary care physicians (PCPs) to accurately interpret and integrate CGM into their practice via a multidisciplinary team approach.

Objective: The primary objective of this study was to evaluate the feasibility and effectiveness of integrating CGM into primary care clinics using a multidisciplinary approach that included a clinical pharmacist (PharmD) and a certified diabetes care and education specialist (CDCES).

Methods: Eighteen PCPs received a 1-hour video training module from an endocrinologist teaching a systematic stepwise approach to CGM interpretation. Patient inclusion criteria included type 2 diabetes mellitus, ≥18 years old, hemoglobin A1c (HbA1c) ≥8% or concern for hypoglycemia, and no previous CGM use or an endocrinology visit in the past year. Patients saw physician extenders (CDCES or a PharmD) for professional CGM placement and education on nutrition, medication administration, and physical activity goals based on the PCP's recommendations. The CDCES or PharmD reviewed CGM data with patients and collaborated with PCPs to adjust the care plan, informed by the systematic stepwise approach to CGM interpretation. Patients either converted to personal CGM if desired or had a second professional CGM device placed after ≥1 month from the initial professional CGM placement and obtained a postintervention HbA1c measurement at ≥3 months from the initial HbA1c measurement. The primary outcomes were time in range, HbA1c, and average time from referral to the first CGM device placement. Follow-up continued with the CDCES or PharmD until patients met the study discharge criteria of HbA1c level ≤7%. Paired t tests with 1-sided P values were used to assess changes in glucose metrics from the initial to postintervention measurements. The McNemar test was used to determine the significance of change in patients meeting the goal of ≥70% time in the target range of 70-180 mg/dL.

Results: The CGM users (n=46) had a mean (SD) age of 62.39 (14.57) years, and 14/46 participants (30%) were female. The mean (SD) time in range increased by 28.06%, from 43.25% (33.41%) at baseline to 71.31% (25.49%) postintervention (P<.001), due to reduced hyperglycemia. The proportion of CGM users meeting the consensus target of the time in range ≥70% increased from 23.81% to 57.14% (P<.001). Postintervention HbA1c decreased by an average of 2.37%, from 9.68% (1.78%) to 7.31% (1.32%; P<.001).

Conclusions: The integration of CGM into primary care clinics to increase patient access is feasible and effective using a multidisciplinary approach.